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Liver cancer is one of the most common and most deadly forms of cancer. The majority of primary cases (where the disease starts in the liver, as opposed to a metastasis from somewhere else) are classified as hepatocellular carcinoma. However, advances in treatment offer improving prognoses, especially when the cancer is detected early.
Surgical resection. Progress in surgical techniques over the last 25 years have made it possible for some liver cancer patients to achieve complete cures by removal of the tumor. However, the success stories are limited to early stage tumors in relatively healthy livers.
Liver transplant. For patients who meet the selection criteria, liver transplant offers the best statistical results. The 5-year survival rate for recipients is reported as 72 to 83 percent. Clearly, this option will not be effective if the cancer has already metastasized to other parts of the body. It is recommended for early stage liver cancer with a maximum of three nodules of limited size. The biggest disadvantage is the shortage of donor organs. Patients on the waiting list may experience disease progression that disqualifies them for a transplant. Research on living donor liver transplants has produced promising results. A partial liver from a healthy donor offers the benefits of optimum surgical conditions. However, this operation still presents significant risks to the donor, who may need a subsequent transplant because of insufficient liver function.
Percutaneous radiofrequency ablation. For patients who are not surgical candidates, this is a widely used technique to kill the tumor with heat. It is more effective than ethanol injection (below), but also has more adverse effects.
Percutaneous ethanol injection (PEI). This is a well-studied technique with few complications. Ethanol is injected into the tumor in multiple sessions, and kills the cancerous cells. For selected patients, the 5-year survival rate can be as high as 72 percent. However, larger tumors are difficult to kill completely.
Chemoembolization. This is a technique to reduce the blood supply to the tumor, and is used primarily in combination with other treatments.
Systemic chemotherapy. Chemotherapy has been less effective for liver cancer than for other cancers, but research continues into drug options.
I found 1,372 clinical trials currently listed for liver cancer.
References:
1. Rampone B et al, “Current management strategy of hepatocellular carcinoma”, World Journal of Gastroenterology 2009 July 14; 15(26): 3210-16.
2. Kahn SA et al, “Surgical treatment for liver cancer”, World Journal of Gastroenterology 2010 Feb 28; 16(8): 927-33.
3. Bouza C et al, “Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma”, BMC Gastroenterology 2009; 9: 31.
4. Clinical trials:
http://clinicaltrials.gov/ct2/results?term=liver+cancer
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.
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It's troubling that the risk to living liver donors was glossed over in this article with the word "significant". It's important that a would-be recipient be informed of the risks to the donor before asking someone to make that sacrifice for them.
Two living liver donors died in the US in 2010 and they weren't the first. In fact, due to the lack of reporting requrements, the exact number is unknown (but last somewhat pegged at 33). A2ALL, the largest in-process study (covering the 9 biggest liver transplant programs in the US), revealed a nearly 40% complication rate for living liver donors, and severe psychological consequences, including suicides, suicide attempts and drug overdoses. Meanwhile, the graft survival rate (as noted in this article) is no better than that of a deceased donor liver.
For more information: www.livingdonor101.com/living_liver_donors.shtml
February 15, 2011 - 2:21pmThis Comment